Protecting peritoneal dialysis patients: evaluation and prevention strategies for noninfectious risk factors

Noninfectious risk factors in peritoneal dialysis (PD) are often overlooked, yet they significantly worsen patient outcomes. This review highlights nine key risk factors: advanced age and psychosocial vulnerability, malnutrition and sarcopenia, glucose and lipid metabolism disorders, hypoalbuminemia, chronic microinflammation, gut dysbiosis, kidney anemia, chronic kidney disease-mineral and bone disorder, and volume overload with elevated intra-abdominal pressure. These factors interact to increase the risks of death, decline of residual kidney function, peritoneal fibrosis and cardiovascular events. We outline practical, evidence-based protective strategies that integrate nutritional and physical rehabilitation, biocompatible dialysis regimens, individualized fluid and dialysis prescription, targeted pharmacotherapy, psychosocial support, and regular monitoring of integrated inflammatory and nutritional biomarkers. The goal is to help clinicians improve long-term outcomes and quality of life for PD patients.